Editor’s note: This article originally ran May 25, 2022 and was updated July 26, 2022 to reflect updated public health guidance.
The worldwide spread of monkeypox has been in the news, so it’s understandable that people are concerned about this virus.
To date, more than 18,000 cases of monkeypox have been confirmed in 68 countries that have not historically reported monkeypox outbreaks, including the United States, Canada, Australia and several countries in Europe. The World Health Organization (WHO) declared the virus a global health emergency on July 23.
However, monkeypox will not be anywhere near as widespread or as devastating as the COVID-19 pandemic, according to UNC Health infectious diseases specialist David Wohl, MD. “Monkeypox is very different than COVID-19. It is much harder to catch and is much less dangerous.”
Still, as with COVID-19, knowing about monkeypox and how you can avoid it is important.
For answers to questions you might have about monkeypox, read on.
1. What is monkeypox?
Monkeypox is a virus that in most cases causes lesions on the skin but sometimes can lead to more serious symptoms such as high fevers, headache, eye infection and lung infection.
Despite the name, monkeypox is not spread by monkeys; rather, it was named after an outbreak of the virus in a laboratory with monkeys in 1958. It was later discovered that rodents in parts of central and western Africa carry the virus, which is in the same family as smallpox.
The first case of monkeypox in humans was seen in 1970, and thousands of cases of monkeypox have been reported in central and western Africa.
Most cases in other parts of the world have been linked to travel to central or western Africa or to animals imported from there. The only other significant outbreak in the United States occurred in 2003, when 47 cases were identified in six Midwestern states. All 47 reported that they had contact with pet prairie dogs. The prairie dogs had been infected after being kept near small rodents imported from West Africa.
2. How contagious is monkeypox?
The monkeypox virus is much harder to spread than the viruses that cause COVID-19 or the flu.
“Unlike those infections, this is not spread by aerosols—tiny particles that can travel well through the air. It takes closer, more direct contact, the kind of intimate contact that you would not get with someone on a subway or a plane,” Dr. Wohl says.
Monkeypox is mostly spread by contact with the lesions of an infected person or with clothes or bedding that have been contaminated. Respiratory droplets containing the monkeypox virus can travel only a few feet, so prolonged face-to-face contact is required for infection.
In the current global outbreak, intimate contact, particularly sexual contact, has been responsible for the majority of infections.
3. What are the symptoms of monkeypox?
Monkeypox symptoms are similar to but much milder than the symptoms of smallpox. Skin lesions are the main symptom and can look like a fluid-filled bump on the skin or an ulcer, like a crater. These can be located anywhere, including the genitals, and can be a single lesion or many on different parts of the body. Often, they itch or hurt. During the current outbreak, painful rectal lesions have been commonly reported.
Some people with monkeypox may first experience fever, headache, muscle aches, fatigue or swollen lymph nodes before they notice any lesions. But some people may not have any of those and only get a skin lesion.
Monkeypox can look like other infections such as chickenpox or shingles, Dr. Wohl says.
“Most adults who’ve had chickenpox don’t get it again,” he says. “They can get shingles, but that’s typically in a patch of skin on one side of the body. Monkeypox lesions can be seen anywhere on the body, including the palms or soles.”
Also, monkeypox lesions can look like those caused by syphilis or herpes simplex. The important thing, Dr. Wohl says, is to see a doctor if you notice a strange new skin bump or ulcer, especially if you are at risk for being infected with monkeypox.
“Not every bump that a person notices should lead to a call to the doctor. Monkeypox do not look like your average pimple. If you see something on your skin that looks unusual, especially if you also have fevers or swollen glands and could have been in close contact with someone who was infected, then you should seek care,” he says.
The illness typically lasts for two to four weeks. The incubation period, from infection to symptoms, is usually one to two weeks.
A test for monkeypox is available and can be done with a swab of a skin lesion.
4. What is the treatment for monkeypox?
Monkeypox is in the same family as smallpox, so the medical community already has diagnostic testing and vaccines for monkeypox, Dr. Wohl says. The Centers for Disease Control and Prevention (CDC) has a stockpile of treatments and vaccines for monkeypox that officials are working to distribute to states as needed.
TPOXX (tecorvirimat) is an antiviral medication that was approved for treatment of smallpox and has shown to be effective in treating monkeypox. Most people don’t need this medicine, though, as most with monkeypox recover fully without treatment.
However, people with very painful lesions or lesions in the eye or mouth may benefit from treatment. Those with weakened immune systems, those who are pregnant, or people a history of certain skin conditions such as eczema that could get aggravated by monkeypox may also be candidate for TPOXX.
Children may become sicker than adults if they get monkeypox because their immune systems are not as strong, and TPOXX can be used in kids.
Before 1972, children were routinely vaccinated for smallpox, leaving a telltale circular scar on their arms. Dr. Wohl says it’s unclear whether people who were vaccinated so long ago are completely protected from monkeypox (or smallpox).
5. Who is most at-risk for contracting monkeypox in 2022?
Anyone can get monkeypox if they come in close contact with lesions of an infected person or with contaminated clothes or bedding, Dr. Wohl says. Most cases in the 2022 outbreak have been among men who have sex with men, most of whom are between 25 and 50 years old.
“Right now, we are seeing this virus spread through networks of men who have sex with men, but it’s a public health concern for everyone,” Dr. Wohl says. “We need to work together to stop the spread of this infection in the communities impacted now and to avoid other communities from being impacted later.”
6. How do I avoid getting monkeypox?
As the monkeypox virus is currently spreading mostly through sexual activity, people who have multiple sex partners are at greater risk of becoming infected.
Condoms might help reduce the risk of sexual transmission, but the virus can be spread from lesions on other parts of the body.
“Reducing your number of sex partners and checking to see if intimate partners have any concerning skin lesions can help reduce the risk of monkeypox, especially at this moment, for men who have sex with men,” Dr. Wohl says. “It is important to know that intimate contact does not just mean sex. As this virus is found within the lesions on the skin or mouth, even kissing and cuddling, unfortunately, carry some risk.”
This does not mean kissing and cuddling are to be completely avoided with new or casual partners, he says, given that the number of cases of monkeypox remain low. But people should pay attention to the rates of new infections in their area.
7. Is there a vaccine to prevent monkeypox?
A vaccine for monkeypox, called JYNNEOS, is being distributed. It was developed for smallpox but has been found to also provide protection against monkeypox.
Those most at risk for infection now, which includes anyone who has been in close contact with someone who has monkeypox, men who have sex with men or transgender individuals who in the past 3 months have had multiple or anonymous sex partners, or a sexually transmitted infection, or are taking medication to prevent HIV, are eligible to receive the vaccine.
Healthcare workers who collect specimens for testing and those who handle them in the laboratory also should get the vaccine.
The JYNNEOS vaccine is available at some health departments and a small number of medical clinics. The number of locations administering the vaccine will increase with supply.
“We are fortunate that we have on hand right now a reliable test, a well-tolerated treatment, and an approved vaccine to control monkeypox,” Dr. Wohl says. “It is with these tools plus people being informed about how to protect themselves and others that will make the difference.”
If you are concerned about symptoms you are experiencing, see your doctor or find one near you.